What is Scoliosis (Curvature of Spine)?
17 May 2020
What is Scoliosis (Curvature of Spine)?
Curvature of spine, also called scoliosis in medical jargon, is three dimensional lateral and rotational curvature of the spine, which may occur when the vertebrae is dislocated towards right or left and also rotates around their axis and which is observed on the chest and/or lower back. Scoliosis is not a disease but a condition.
Curvature of spine may develop in all age groups on various parts of the spine and generally occurs in people at the age range of 10-15, just before growth spurt.
What is Scoliosis (Curvature of Spine)?
On a normal and healthy backbone, the vertebrae extends on a straight line downwards when looked from behind.
Healthy spine system consists of a total of 33 bones, 12 of which are mobile, and vertebrae is a structure in which the bones are interconnected through connective tissues, joint and disc tissues. The vertebrae is located between the head and legs and is seen on a straight line when looked from front and behind. When looked from the sides, however, the spine has a natural curve forward on the neck, outward on the back and again forward on the lower back. It has an “S” shape and physiological curves when looked from sideways.
Physiological curves are named:
Frontward on the neck (lordosis)
Backwards on the back (kyphosis)
Frontward on the lower back (lordosis).
In case of scoliosis, there is a 3D deformity on the spine. Curvature of spine mostly develops just before puberty and is mild. Mild cases usually do not show symptoms. However, in some cases, severity of the curvature increases with the growth of the person. In severe cases, internal organs are pressed depending on the curvature. Such cases particularly affect heart and lungs may cause impairment in the organs’ functions.
What Causes Curvature of Spine?
Scoliosis may develop structurally, that is depending on problems originating from the spine itself, or reactively, that is due to various reasons concerning spine. Curvature of spine may develop congenitally or due to muscle and nerve diseases, or inexplicably in some people.
The scoliosis occurs more commonly in girls of puberty age, however the reason of scoliosis is not definite. Infections during pregnancy, diabetes and the deficiency of some vitamins or minerals are thought to play a role in scoliosis development. Although it is not accurately demonstrated, genetic factors are also known to play a role in the development of disease.
Besides, neuromuscular diseases such as cerebral palsy and muscular dystrophy, congenital disorders affecting spine development, spine traumas and infections affecting spine are thought to cause scoliosis.
What are Types of Curvature of Spine?
Spine deformity may in some cases develop with the aggravation of hump or curve of lower back. Scoliosis may be resulted from various reasons.
Although no sufficient findings about whether the disease is genetic are obtained as the result the limited studies, it must also be considered that genetic factors have also an impact on the disease development. Classification of curvature of spine is also performed based on the cause of the disorder.
Idiopathic scoliosis: Since the cause of this curvature of spine recognized at childhood or adolescence is not known, it is called idiopathic scoliosis. This kind of curvature begins at an early age, but develops without any symptom of pain or posture impairment. However, with the advanced age and continuation of growth, troubles caused by curvature of spine start to be felt and the patient may recognize balance disorders and degeneration in his/her body. Besides, complaints of pain that were absent in childhood also appear in the patient.
In general, scoliosis in adolescence develops in the chest and rib cage sections of the spine. Deformities in these sections cause the patients to complain from respiratory distress. The patient also complains from back ache and impaired mobility due to the disruption of small joints interconnecting the vertebrae at the back of the spine and playing an important role in the spine’s mobility.
Congenital Scoliosis: There is no clear data on the prevalence of congenital scoliosis, however it is known to occur more rarely than idiopathic scoliosis. Further, the studies performed up to today have not proven the existence of genetic predisposition.
Congenital scoliosis develops in the womb. Various reasons such as infections suffered in the womb, the diabetes that mother suffered priorly or during pregnancy, heart conditions, hyperthermia, alcohol, valproic acid use, vitamin and mineral deficiencies of the body and the like are indicated for the development of congenital scoliosis. Nonetheless, some hereditary diseases are observed to accompany congenital scoliosis. Frequently, it progresses rapidly on the first few years after birth.
Structural defects may cause the formation of congenital scoliosis in various ways. Structural problems developing in the womb manifest themselves in formation defects and cleavage defects of the spine. In some patients, both defects may coexist. Curvatures of spine originating due to developmental defect in the womb are usually observed as impacted ribs.
Another significant feature of congenital scoliosis is its coexistence with spinal cord, kidney and heart anomalies. Concomitant anomalies may be seen in spinal cord (41%), heart (7-12%) and kidneys (20%) in addition to congenital scoliosis.
In congenital scoliosis, which is generally progressive, curvature may not be observed at the beginning despite of the fact that the baby is born with an abnormal spine. Curvature usually manifests itself with the continuation of growth. In some cases, curvature progresses extremely slowly until rapid growth stage of adolescence.
Therefore, parents need to be extremely careful for early diagnosis of congenital scoliosis. As soon as the parents observe any imbalance or difference on the baby’s neck, back, lower back they must immediately consult a physician. Early term congenital scoliosis treatment process may require surgical intervention at young ages.
Besides, a secondary curvature of spine may develop in children with congenital scoliosis in order to ensure physical integrity and balance over or under the curvatures due to spine anomalies. In fact, since this curvature may in time grow larger than primary curvature, a regular curvature follow-up is also necessary after the diagnosis.
In congenital scoliosis, development of the deformity in age groups of 0-5 and 10-15, in which maximum spine growth is observed must be followed more frequently.
The type of treatment must be determined as per increase potential of the deformity.
Symptoms of congenital scoliosis include:
Increase in hairing of especially lower back,
Changes in skin color,
Bone spur at the back, located by hand,
Shorter torso in proportion to the legs,
Uneven alignment of vertebrae when looked from behind,
Unless an increase is observed in congenital scoliosis cases, curvature is followed periodically with physical examinations and X-ray scans. This follow-up procedure continues until the skeleton system reaches maturity and, in case of a surgical operation, after the operation.
Surgical treatment is the only option in cases with a high probability of progress and in which a progress has been determined within follow-up process. In most cases, surgical treatment is the most common treatment method curvature increases and corset treatment has failed in majority of cases.
Idiopathic Scoliosis: In idiopathic curvature of spine, also known as inexplicable scoliosis, curvature in the spine may have an “S” or “C” shape. In addition to the bending to sideways, the person’s vertebrae may rotate around their own axes. The rotation of vertebrae around themselves results in the asymmetric protrusions in the person’s back and lower back.
Idiopathic scoliosis is characterized by inexplicable curvature of a healthy spine and is defined under different names according to the time it has started. In other words, curvatures occurring between 0-3 years of age are named infantile-onset, the type occurring between 4-9 years of age are named juvenile-onset and curvatures of spine occurring between 10-18 years of age are named adolescence onset idiopathic scoliosis. This is most common type of curvature of spine.
Neuromuscular Scoliosis: Neuromuscular scoliosis is the second most common scoliosis type and its main causes include muscular and/or nerve disorders. Usually, in addition to the muscular diseases that developed in childhood and later, it may develop due to nerve diseases associated with brain and spinal cord. Neuromuscular scoliosis patients suffer more commonly from respiratory distress and sensation disorders.
What are the Signs of Scoliosis?
Scoliosis symptom requiring the patient to see a doctor is usually the pain and weakness in lower back. However, despite pain, most adult scoliosis cases do not cause symptoms. In some cases, changes in the body, loss of stature and imbalance of the body occur. The patient usually notices by him/herself the symptoms of scoliosis such as clothes not fitting to his/her body or looking properly, shortening of his/her neck, deformation on the back when bending down.
Some of the common symptoms in scoliosis (curvature of spine) are as follows:
Clear presence of curvature when looked from across at the spine,
Curvature or bending towards right or left,
Difference in crotch and shoulder levels,
Difference in extent of the body and arms,
Impaired body balance,
Disproportionate sight of ribs,
Asymmetry of rib cage,
Bulge on one of the shoulder bones,
Walking with one shoulder ahead,
Feeling as if one leg is longer than the other while walking,
Back and/or lower back pains,
Shortness of breath,
Unfitting of clothes to the body.
Increase of pressure on the nerves due to scoliosis may result in leg pain, tiredness, spasms on the back and lower back muscles. Complaints of weakness, numbness and pain on the legs increase in patients whose condition has advanced and nerve pressures have increased. Deformation of rib cage due to scoliosis may result in heart and respiratory problems.
What are the Grades of Scoliosis?
The majority of the scoliosis cases with a prevalence of 2% to 4% in society consists of low grade curvatures. In other words, only 10% of curvatures of spine are at a grade requiring treatment. Especially the prevalence of curvatures over 30 degrees in girls is about 10 times that of the boys.
Curvatures of spine are assessed with geometrical gradation. Curvatures of spine under 10 degrees are called spinal asymmetry and are not defined as scoliosis. In other words, in order to diagnose an person with curvature of spine, the curvature must be 10 degrees and above. Scoliosis grades are classified in three types; mild, moderate and severe.
Mild scoliosis: Patients in this group with curvatures of spine of 10 to 20 degrees are not usually required a surgical treatment. However, they must be followed to tell if the scoliosis has progressed. Improvement of body muscles, correction of posture, increase in the mobility of stiff body structures are aimed in this patient group.
It is ensured via specific exercises that abdominal wall and body extensor muscles are strengthened, structures on the concave side of the curvature are stretched, lateral flexors of the body on the convex side of the curvature are strengthened. Deep breathing exercises are also applied to patients to improve pulmonary function.
Moderate scoliosis: Moderate curvature of spine, the term used to define curvatures of 20 to 40 degrees, is mostly identified in adolescence.
The aim of corset use is to prevent scoliosis inclination increase. Corset is especially effective in children with a curvature of over 25 degrees, whose growth continues. The corset’s effect begins to decrease in children with a curvature of over 40 degrees, who have many years ahead to complete development of skeleton. Curvature may also increase despite corset treatment. This rate of increase can be confirmed today at a rate of 99% through gene analysis studies from saliva sample and this analysis is performed at Group Florence Nightingale Hospitals Scoliosis and Spine Center.
Severe curvature of spine: Curvatures of spine over 40 degrees may lead to an impact on the heart and lungs. Surgical treatment is the first option for curvatures over 40 degrees and in patients with an ongoing potential of growth.
What are Scoliosis (Schroth) Exercises?
In scoliosis exercises, a scoliosis-specific rehabilitation program, impaired body balance is regulated through Schroth method involving a 3 dimensional approach.
Exercises are performed by means of exercise bars and mirrors, under guidance of the therapist.
The exercises include stretching, proper positioning of arms and body and strengthening the muscles. It is aimed to fix the curvatures by applying pressure on various parts of the body with floor exercises and sandbags. Exercise also includes exercises for respiratory techniques. Correction of asymmetric posture and maintenance of the corrected posture in daily life are intended.
Schroth scoliosis exercises may be performed individually or in group therapies. The program is supported by home exercises. This program may be effective in reducing scoliosis related pains.
How to Discover Scoliosis (Curvature of Spine)?
In case of failure to intervene at an early stage, scoliosis may cause irrecoverable damages on heart and respiratory system as well as cosmetically.
In scoliosis, curvature developed depending on deformity of spine may be alone or accompanied by kyphosis (hunchback) characterized with bending forward.
Scoliosis is diagnosed by whole spine screening and clinical examination. At front-back and side x-ray scans of of whole spine, which are taken on foot, the angle between vertebrae that the curvature begins and ends is measured. Progress of this angle is monitored at intervals.
EOS allows simultaneous 3 dimension screening of whole body or a certain region from front-back and sides.
EOS is especially used in displaying spine diseases such as scoliosis and kyphosis. EOS screening provides detailed information before many orthopedic surgeries.
Many screening processes shall be required to follow some patients, especially children with curvature of spine. There are concerns with the adolescents frequently exposed to examination through standard methods that some side effects may increase due to radiation exposure. Herein, EOS stands out with its low radiation rate.
How to Treat Scoliosis?
Treatment process of scoliosis varies depending on the disease triggering scoliosis and the scoliosis that has developed in the person. In other words, there is not a correct and single treatment option to applied for scoliosis. Proper treatment is determined in consideration of the age scoliosis diagnosis has been made, the position and degree of curvature, the underlying reason causing scoliosis and the radiological findings.
There are usually 3 alternatives for the treatment:
Monitoring: The first alternative is monitoring and curvatures under 20-25 degrees are thus monitored at regular intervals. The person must also engage in sports activities and increase overall body condition during monitoring.
Corseting: This is an effective method in individuals with a curvature of 20-40 degrees and potential of growth. Regular corset use drops the probability of surgery. In order for the corset to be effective, it must be worn 20-23 hours a day.
Surgical Treatment: Surgery is a method generally considered for curvatures over 40-45 degrees. Scoliosis straightening and hardening (fixing) operations are performed on individuals with developed lungs. Treatment in scoliosis surgery is successfully performed by means of implants placed in the back and lower back (screw-stick). Monitoring spinal cord functions during the surgery (neuromonitorization) is a method that increases reliability of the procedure for the patient and the physician.
Novelties in Scoliosis Surgery
Tape Stretching Method (Anterior Tethering)
Tape stretching technique was developed as an alternative to fusion surgery, a standard treatment applied with screws and sticks (fixing-hardening) in scoliosis cases requiring surgical treatment. In this technique applied with minimal invasive approach, screws are placed in chest or waistline by small cuts and straightening is performed by means of stretching technique over a specially designed polyethylene tape. Especially in cases with an ongoing potential for growth, “non-fusion surgery” technique gives successful results. As curvatures are straightened with this technique, flexibility is fully preserved.
In adult scoliosis treatment, various physiotherapies are applied under guidance of the physiotherapist in order to strengthen and keep in balance the spine in the first place. Pain control of the patient is established through medications. In some cases, non-steroidal anti-inflammatory drugs (NSAIDs) may be given to eliminate the irritation and inflammation in facet joints or due to nerve pressure. Surgery is considered in people who do not respond all these treatments and whose curvature increase continue or pains cannot be eliminated.
You can ask the expert team of Group Florence Nightingale Hospitals about the issues that you wonder about curvature of spine (scoliosis) and ask for suggestions regarding your question. To contact us, you can use the contact form on our web site or call 0 850 711 60 60.